Dear Doc: Will oral doses replace allergy shots?

I’ve read about the newly available oral drops for allergy. Could that replace my current allergy shot?

A quick answer for you is “no;” a longer answer to your question is “perhaps in the future.”

The reason I say “no” is that your current allergy shot contains extracts for nine different grasses, including, Bahia; seven different molds, ragweed and three other Florida weeds; plus seven different trees, including oak.

Right now drop therapy is only available for single allergens and these are extremely limited in their spectrum. For instance, the only serum for grass is for Timothy grass. We have Timothy grass in Florida, but it is a minor contributor to our grass pollen burden, as opposed to the Bahia Grass family and Bermuda grass. The only weed extract available is for short ragweed, one type we have in Florida. More prominent, however, are the giant and southern ragweed plants. And so it goes . . .

It has been known for more than 100 years that allergy immunotherapy works best when all the relevant allergens are addressed.

Another issue is cost. At present, the oral therapy is quite expensive and is not being covered by insurance companies. Part of the reason for the expense is that drug therapy must be done daily requiring a lot of allergy serum.

Finally, like any new modality “the bugs need to be worked out.” One “bug” is that up to 50 percent of people taking oral treatments have unpleasant side effects of mouth and tongue itching, along with stomach upset. These side effects are occurring with just one allergen in the serum so when multiple allergens are available, these problems could become greater nuisances.

Technology always seems to improve current standards, so I have no doubt oral therapy will eventually join allergy shot therapy and perhaps replace it, but there is a long way to go.